Clarke Richard M, O'Hickey Stephen P, Walklet Elaine, Bradley Eleanor, Mahoney Berenice
School of Education and Sciences, University of Gloucestershire, Cheltenham, UK.
Respiratory and General Medicine, Worcestershire Acute Hospitals NHS Trust, Worcester, UK.
Hum Vaccin Immunother. 2025 Dec;21(1):2561457. doi: 10.1080/21645515.2025.2561457. Epub 2025 Sep 16.
This study examines healthcare practitioners' decision-making processes when managing vaccine-hesitant patients concerned about allergic reactions to COVID-19 vaccines. A multi-methods secondary data analysis was conducted combining quantitative referral trends and qualitative thematic analysis of health practitioner recorded notes. Anonymized data from 326 individuals referred to an interim COVID-19 vaccine allergy advice service based in Herefordshire and Worcestershire, UK, were analyzed. Quantitative data included referral patterns and vaccination outcomes, while qualitative data consisted of thematic analysis of free-text health practitioner notes documenting patient concerns and practitioner decision-making. Of the referred cases, 23.3% were advised to proceed with vaccination in primary care without precaution, 29% with additional precautions such as antihistamines and extended observation. Hospital-based vaccination was only recommended for 0.9%, typically for individuals with complex allergy histories. In 22.7%, cases were escalated to a multidisciplinary team that mainly advised vaccination in primary care with precautions or in hospital settings. Notably, no cases resulted in recommendations against vaccination. The qualitative analysis of health practitioner free text notes developed three themes: diverse presentation of allergies, complex allergy histories, and patient anxiety and lack of trust. Themes suggest healthcare practitioners face significant challenges in clinical decision-making with these patients and highlight the complexity of managing vaccine hesitancy. This study underscores the need for enhanced training and standardized documentation processes to support healthcare practitioners in managing allergy-related vaccine hesitancy. Public health messaging should proactively address misconceptions about vaccines as they relate to allergies, to build trust and reduce hesitancy.
本研究考察了医疗从业者在管理对新冠疫苗过敏反应存在疑虑的患者时的决策过程。采用了多方法二次数据分析，结合了定量转诊趋势和对医疗从业者记录笔记的定性主题分析。对来自英国赫里福德郡和伍斯特郡的一家临时新冠疫苗过敏咨询服务机构的326名个体的匿名数据进行了分析。定量数据包括转诊模式和疫苗接种结果，而定性数据则包括对记录患者担忧和从业者决策的自由文本医疗从业者笔记的主题分析。在被转诊的病例中，23.3%的患者在初级保健中被建议无需采取预防措施即可接种疫苗，29%的患者需要采取额外的预防措施，如使用抗组胺药和延长观察时间。仅0.9%的病例被建议在医院接种疫苗，通常是针对有复杂过敏史的个体。22.7%的病例被提交给多学科团队，该团队主要建议在初级保健中采取预防措施接种疫苗或在医院环境中接种。值得注意的是，没有病例被建议不接种疫苗。对医疗从业者自由文本笔记的定性分析形成了三个主题：过敏表现多样、过敏史复杂以及患者焦虑和缺乏信任。这些主题表明，医疗从业者在对这些患者进行临床决策时面临重大挑战，并突出了管理疫苗犹豫的复杂性。本研究强调需要加强培训和规范文档流程，以支持医疗从业者管理与过敏相关的疫苗犹豫。公共卫生宣传应积极解决与过敏相关的疫苗误解，以建立信任并减少犹豫。
